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晚期食管腺癌的软脑膜癌病：一例关于临床表现与诊断的病例报告

Leptomeningeal carcinomatosis in advanced esophageal adenocarcinoma: A case report on presentation and diagnosis.

作者信息

Grabill Nathaniel, Louis Mena, Adams Richard, Gherasim Claudia, So Sumi, Stevens Timothy

机构信息

Northeast Georgia Health System Inc, General Surgery Department, 743 Spring Street NE, Gainesville, GA 30501, United States of America.

Northeast Georgia Health System Inc, General Surgery Department, 743 Spring Street NE, Gainesville, GA 30501, United States of America.

出版信息

Int J Surg Case Rep. 2025 Jan;126:110708. doi: 10.1016/j.ijscr.2024.110708. Epub 2024 Dec 3.

DOI:10.1016/j.ijscr.2024.110708
PMID:39642415
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11667075/
Abstract

INTRODUCTION AND IMPORTANCE

Leptomeningeal carcinomatosis (LC) is an uncommon but severe complication of advanced esophageal adenocarcinoma. Typically diagnosed through MRI and cerebrospinal fluid analysis, LC carries a poor prognosis despite aggressive management.

CASE PRESENTATION

A 64-year-old male with a history of coronary artery disease, diabetes, and other comorbidities presented with progressive dysphagia. Diagnostic imaging and biopsy confirmed esophageal adenocarcinoma with local invasion and distant metastases, including mediastinal lymphadenopathy. Despite treatment with chemotherapy, radiation, and surgical interventions such as jejunostomy tube placement, the patient developed neurological symptoms suggestive of LC. MRI confirmed leptomeningeal involvement, and cerebrospinal fluid analysis revealed malignant cells.

CLINICAL DISCUSSION

Management focused on palliative care, including chemotherapy and radiation. The patient's condition deteriorated rapidly, consistent with the poor prognosis associated with LC in esophageal cancer.

CONCLUSION

This case discusses the importance of early detection and intervention in managing esophageal adenocarcinoma, particularly when neurological symptoms suggest central nervous system involvement. Despite advances in cancer treatment, LC remains a difficult condition to manage, with limited effective therapeutic options.

摘要

引言与重要性

软脑膜癌病（LC）是晚期食管腺癌一种罕见但严重的并发症。通常通过磁共振成像（MRI）和脑脊液分析进行诊断，尽管采取积极治疗，LC的预后仍很差。

病例介绍

一名64岁男性，有冠状动脉疾病、糖尿病和其他合并症病史，出现进行性吞咽困难。诊断性影像学检查和活检证实为食管腺癌伴局部侵犯和远处转移，包括纵隔淋巴结肿大。尽管接受了化疗、放疗和诸如空肠造瘘管置入等外科干预措施，患者仍出现提示LC的神经症状。MRI证实软脑膜受累，脑脊液分析发现恶性细胞。

临床讨论

治疗重点为姑息治疗，包括化疗和放疗。患者病情迅速恶化，与食管癌中LC相关的不良预后一致。

结论

本病例讨论了早期检测和干预在食管腺癌管理中的重要性，尤其是当神经症状提示中枢神经系统受累时。尽管癌症治疗取得了进展，但LC仍然是一种难以管理的疾病，有效治疗选择有限。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/dc6d8ae6f061/gr11.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/a1fd82e5fc49/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/dc6d8ae6f061/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/807864cce3a1/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/4000f34eb606/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/b0068803a057/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/d6a90a89e6b8/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/3551a86912be/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/92f6790c95a2/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/f342c14cd947/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/3733971f741e/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/43b322f73e55/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/a1fd82e5fc49/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e92f/11667075/dc6d8ae6f061/gr11.jpg

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Leptomeningeal carcinomatosis and brain metastases in gastroesophageal carcinoma: a real-world analysis of clinical and pathologic characteristics and outcomes.胃食管腺癌中的脑膜癌病和脑转移：真实世界的临床和病理特征及预后分析。
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